Trident Medical Group PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

TRIDENT MEDICAL GROUP PA

Practice address

325 N Saint Paul St Ste 3100
Dallas, TX 75201-3923

Phone

(855) 770-7771

NPI assigned

Dec 21, 2021

Last updated

Nov 14, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Devion Smith

Title

Director, Payer Contracting

Phone

(424) 326-8711

Specialties & licenses 4

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668384000000",
    "number": "1275293078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "382 NE 191ST ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331793899",
            "telephone_number": "310-626-0149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N SAINT PAUL ST STE 3100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752013923",
            "telephone_number": "855-770-7771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIDENT MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-21",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DEVION",
        "authorized_official_title_or_position": "DIRECTOR, PAYER CONTRACTING",
        "authorized_official_telephone_number": "424-326-8711"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213EP0504X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Public Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.